Feeling, learning from and being aware of inner states: interoceptive dimensions in neurodegeneration and stroke
Open accessAbstract
Interoception is a complex process encompassing multiple dimensions, such as accuracy, learning and awareness. Here, we examined whether each of those dimensions relies on specialized neural regions distributed throughout the vast interoceptive network. To this end, we obtained relevant measures of cardiac interoception in healthy subjects and patients offering contrastive lesion models of neurodegeneration and focal brain damage: behavioural variant fronto-temporal dementia (bvFTD), Alzheimer's disease (AD) and fronto-insular stroke. Neural correlates of the three dimensions were examined through structural and functional resting-state imaging, and online measurements of the heart-evoked potential (HEP). The three patient groups presented deficits in interoceptive accuracy, associated with insular damage, connectivity alterations and abnormal HEP modulations. Interoceptive learning was differentially impaired in AD patients, evidencing a key role of memory networks in this skill. Interoceptive awareness results showed that bvFTD and AD patients overestimated their performance; this pattern was related to abnormalities in anterior regions and associated networks sub-serving metacognitive processes, and probably linked to well-established insight deficits in dementia. Our findings indicate how damage to specific hubs in a broad fronto-temporo-insular network differentially compromises interoceptive dimensions, and how such disturbances affect widespread connections beyond those critical hubs. This is the first study in which a multiple lesion model reveals fine-grained alterations of body sensing, offering new theoretical insights into neuroanatomical foundations of interoceptive dimensions. This article is part of the themed issue ‘Interoception beyond homeostasis: affect, cognition and mental health’.
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Atypical interoception and high alexithymia have been observed in neurological conditions such as Frontotemporal dementia, Alzheimer's Disease, Parkinson's Disease, and Multiple Sclerosis.
“Atypical interoception and high alexithymia have also been observed in neurological conditions with similar symptom profiles, such as Frontotemporal dementia (behavioural variant; García-Cordero et al., 2016; Salvato et al., 2018; semantic variant; Sturm and Levenson, 2011), Alzheimer’s Disease (García-Cordero et al., 2016), Parkinson’s Disease (Assogna et al., 2012; Ricciardi et al., 2016), and”
From Atypical interoception as a common risk factor for psychopathology: A review (2021) · cites this paper as García-Cordero et al., 2016
The Behavioural results report poorer interoceptive accuracy and awareness in behavioural-variant frontotemporal dementia and Alzheimer’s disease than in controls. The paper does not report high alexithymia in either group. The citation is attached to those two conditions, not to the separately cited Parkinson’s disease example. (LLM, conf=0.89)
Experimental — accuracy not yet measuredTurning attention inwards and explicitly attending to one's own heartbeats consistently modulates HERs.
“Turning attention inwards and explicitly attending to one's own heartbeats consistently modulates HERs 92-98 .”
From Interoceptive rhythms in the brain (2023) · cites this paper as [97]
Dysfunctional allostatic-interoception occurs in behavioural-variant frontotemporal dementia (bvFTD) patients.
“Dysfunctional allostatic-interoception, altered processing of bodily signals in response to environmental demands, occurs in behavioural-variant frontotemporal dementia (bvFTD) patients.”
From Altered spatiotemporal brain dynamics of interoception in behavioural-variant frontotemporal dementia (2025) · cites this paper as [18]
The transient and dynamic nature of these interoceptive deficits in people with bvFTD or AD is unclear, and previous evidence of interoceptive deficits has been largely derived from traditional, static, or behavioural measures.
“The transient and dynamic nature of these interoceptive deficits in people with bvFTD or AD is unclear, and previous evidence of interoceptive deficits has been largely derived from traditional, static, or behavioural measures.17, 18, 19”
From Altered spatiotemporal brain dynamics of interoception in behavioural-variant frontotemporal dementia (2025) · cites this paper as [18]
Some evidence suggests that Alzheimer's disease (AD) also disrupts interoceptive and allostatic processes, as well as cardiovascular indices.
“Some evidence suggests that Alzheimer's disease (AD) also disrupts interoceptive and allostatic processes,18 as well as cardiovascular indices.23,25”
From Altered spatiotemporal brain dynamics of interoception in behavioural-variant frontotemporal dementia (2025) · cites this paper as [18]
A validated heartbeat detection (HBD) task was used.
“A validated heartbeat detection (HBD) task was used,18, 19, 20,32, 33, 34,50 where participants completed two 2-min blocks of interoception or exteroception.”
From Altered spatiotemporal brain dynamics of interoception in behavioural-variant frontotemporal dementia (2025) · cites this paper as [18]
Our sample size is similar to other studies using EEG and VBM techniques in neurodegenerative conditions.
“Moreover, our sample size is similar to other studies using EEG and VBM techniques in neurodegenerative conditions.17, 18, 19, 20”
From Altered spatiotemporal brain dynamics of interoception in behavioural-variant frontotemporal dementia (2025) · cites this paper as [18]
This different pattern of results in bvFTD and AD may reflect the preferential and widespread damage within the AIN in bvFTD whereas in AD, AIN damage appears to be more circumscribed.
“This different pattern of results in bvFTD and AD may reflect the preferential and widespread damage within the AIN in bvFTD11,14,16, 17, 18, 19, 20,24 whereas in AD, AIN damage appears to be more circumscribed.17,38,88”
From Altered spatiotemporal brain dynamics of interoception in behavioural-variant frontotemporal dementia (2025) · cites this paper as [18]
There is some emerging evidence of impaired interoceptive accuracy in both AD and PD, but this is not consistently observed.
“In addition, there is some emerging evidence of impaired interoceptive accuracy in both AD and PD (Abrevaya et al., 2020; Garcı ´a-Cordero et al., 2016; Ricciardi et al., 2016; Santangelo et al., 2018), however this is not consistently observed (Salamone et al., 2021)”
From Thinking versus feeling: How interoception and cognition influence emotion recognition in behavioural-variant frontotemporal dementia, Alzheimer's disease, and Parkinson's disease (2023) · cites this paper as García-Cordero et al., 2016
Emerging studies have shown that bvFTD patients have impaired interoceptive accuracy, although results are mixed and limited by small sample sizes.
“Emerging studies have shown that bvFTD patients have impaired interoceptive accuracy (Abrevaya et al., 2020; Garcı ´a-Cordero et al., 2016; Salamone et al., 2021; but see Marshall et al., 2017), although results are mixed, and limited by small sample sizes.”
From Thinking versus feeling: How interoception and cognition influence emotion recognition in behavioural-variant frontotemporal dementia, Alzheimer's disease, and Parkinson's disease (2023) · cites this paper as García-Cordero et al., 2016
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Estimation of Current and Future Physiological States in Insular Cortex
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Moguilner, S., García, A. M., Perl, Y. S., Tagliazucchi, E., Piguet, O., Kumfor, F., Reyes, P., Matallana, D., Sedeño, L., & Ibáñez, A. (2021) · NeuroImage · doi:10.1016/j.neuroimage.2020.117522 · Cited by 63 · see citing works
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Self-citation
- Authors
- García-Cordero, I., Sedeño, L., de la Fuente, L., Slachevsky, A., Forno, G., Klein, F., Lillo, P., Ferrari, J., Rodriguez, C., Bustin, J., Torralva, T., Baez, S., Yoris, A., Esteves, S., Melloni, M., Salamone, P., Huepe, D., Manes, F., García, A. M., & Ibañez, A.
- Affiliations
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Pacheco de Melo 1860, C1126AAB, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (AR)
- Clínica Alemana (CL)
- Favaloro University (AR)
- University of Chile (CL)
- Geriatric psychiatry and Memory Clinic; Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Pacheco de Melo 1860, C1126AAB Buenos Aires, Argentina
- Adolfo Ibáñez University (CL)
- ORCID
- Venue
- Philosophical Transactions of the Royal Society B: Biological Sciences
- Publisher
- The Royal Society
- Published
- 2016-11-19
- Volume
- 371
- Issue
- 1708
- Pages
- 20160006
- ISSN
- 0962-8436 (ISSN-L)
- 1471-2970
- PMC
- PMC5062096
- OpenAlex
- W2530194423
- Cited by
- 199
- References
- 83
- Citations by year
- 2026: 9 · 2025: 14 · 2024: 16 · 2023: 15 · 2022: 17 · 2021: 28 · 2020: 23 · 2019: 34 · 2018: 20 · 2017: 16 · 2016: 7
- FWCI
- 22.80
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Philosophical Transactions of the Royal Society B Biological Sciences (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Americanae (AECID Library) (submittedVersion, cc-by-nc-nd)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by-nc-nd)
- Universidad de Chile (submittedVersion, cc-by-nc-nd)
- Conicet (submittedVersion, cc-by-nc-sa)
- Funders
- FONDAP (15150012)
- INECO Foundation
- Departamento Administrativo de Ciencia, Tecnología e Innovación (1115-545-31374, contract: 392)
- FONCyT-PICT (2012-0412, 2012-1309)
- CONICET, CONICYT/FONDECYT Regular (1130920 and 1140114)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Life Sciences › Neuroscience › Cognitive Neuroscience › Tactile and Sensory Interactions
- Keywords
- interoception, interoceptive accuracy, interoceptive awareness, cardiac interoception, Alzheimer's disease, resting-state functional connectivity, metacognition, insight deficits, neurodegeneration
- MeSH terms
- Aged, Awareness, Female, Humans, Learning, Male, Middle Aged, Neurodegenerative Diseases, Stroke, Interoception
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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